Provider Demographics
NPI:1306452693
Name:ROBERTS, ALEXANDRA BEUTTELL (DNP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:BEUTTELL
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-1510
Mailing Address - Country:US
Mailing Address - Phone:321-727-7992
Mailing Address - Fax:321-727-7664
Practice Address - Street 1:1326 MALABAR RD SE STE 1
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2502
Practice Address - Country:US
Practice Address - Phone:321-727-7992
Practice Address - Fax:321-727-7664
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP11010777363L00000X
FL11010777363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner